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352 Cards in this Set
- Front
- Back
- 3rd side (hint)
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Esophaggeal Bleeding (3)
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Mallory-Weiss Tear
Esophageal Varices Boerhaave's Syndrome |
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Mucosal tear of GE junction from vomiting
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Mallory-Weiss Tear
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Are Mallory-Weiss Tears painful?
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Painless bleeding
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Mallory-Weiss Tear Dx
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EGD
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Mallory-Weiss Tear Tx
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Supportive
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Dilated sub-mucosal veins in lower esophagus
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Esophageal Varices
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2 diseases common with Esophageal Varices
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Portal HTN
Cirrhotic liver disease |
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Brisk, painless bleeding
Life-threatening emergency |
Esophageal varices
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Esophageal Varices Dx
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EGD
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Esophageal Varices Immediate Tx
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EGD is Dx and Tx
Variceal Banding Sclerotherapy |
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Esophageal Varices Long-Term Tx
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Beta Blocker
No ETOH |
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Esophageal rupture/perforation
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Boerhaaves's Syndrome
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2 causes of Boerhaave's Syndrome
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Instrumentation (EGD)
Severe retching/overeating |
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Hematemsis with severe retrosternal "tearing" pain
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Boerhaave's Syndrome
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Boerhaave's Syndrome Tx
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CXR shows mediastinal widening
Esophogram rupture of lower esophagus |
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Boerhaave's Syndrome Dx
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Not self-ltd
Emergent surgical consult |
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Painful swallow
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Odynophagia
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Difficult swallow
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Dysphagia
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Infectious Esophagitis cause
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Candida esophagitis
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Infectious Esophagitis Tx
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Anti-fungal
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New Onset upper GI complaint
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Pill-Induced Esophagitis
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Pill-Induced Esophagitis causes (4)
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NSAIDs
KCl Alendronate/Bisphosphonates Doxy/Tetra |
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Dysphagia Dx
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EGD
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Dx to assess peristalsis/lower esophageal sphincter
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Swallow or Esophageal Manometry
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Oropharyngeal
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CNS
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Motility disorder of solids and liquids
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Achalasia
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Innervation abnormality dysphagia (4)
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Achalasia
Esophageal spasm Scleroderma CVA |
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Structural abnormality dysphagia (4)
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Schatzki's rings
Zenker's diverticulum Esophageal web/stricture Esophageal cancer |
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Poor peristalysis with ineffective swallow induced relaxation of the lower esophageal sphincter
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Achalasia
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EGD image
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"Bird's Beak"
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Achalasia Dx
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Esophageal monometry shows poor peristalsis
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Achalasia Tx
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Botox injections at LES
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Incoordinated motility
Nonpropulsive hyperperistalysis "Food gets stuck" LES normal |
Diffuse Esophageal Spasm
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Hyperperistalysis
LES HTN |
Nutcracker esophagus
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Diffuse Esophageal Spasm Tx
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Self-LTD
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Smooth, circumferential structures in the distal esophagus
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Schatzki Ring
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May develop from uncontrolled GERD, trauma (nasogastric tube), or infectious esophagitis
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Esophageal Stricture
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Schatzki Ring Tx
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EGD
GERD/Infection Tx |
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Schatzki Ring Dx
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EGD shows smooth lumen narrowing
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Esophageal Stricture Tx
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EGD
GERD/Infection Tx |
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Esophageal Stricture Dx
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EGD shows smooth lumen narrowing
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Regurgitation of undigested food, especially in am by older pt
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Zenker's Diverticulum
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Zenker's Diverticulum Dx
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Barium esophagram (Do not want to risk blindly perforating during EGD
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Zenker's Diverticulum Tx
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Surgical in severe cases
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May develop from result of Iron Difficiency anemia
Causes connective tissue effect |
Esophageal Web
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Plummer Vinson Syndrome
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Iron Difficency Anemia caused esophageal web
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Esophageal Web Tx
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Tx anemia
EGD |
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Plummer Vinson Syndrome Tx
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Tx anemia
EGD |
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2 types of Esophageal Cancer
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Squamous
Adenocarcinoma |
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Squamous cell Esophageal Cancer ptss
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Smokers, ETOF in SE Asians/African Americans
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Adenocarcinoma Esophageal Cancer Pts
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Barrett's Esophagus (White males)
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Esophageal Cancer Dx
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EGD for biopsy
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Esophageal Cancer Tx
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Surgical/Onc
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Why use Barium Swallow?
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Machanical v. motility disorders
Dilation and beaking (achalasia) Rings, strictures, Zenker's Diverticulum |
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Why use Manometry
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Assesses peristalsis in Achalasia
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Uncomplicated GERD Tx
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4 weeks on PPI
Test/treat for H. pylori |
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Reasons to send GERD pt for EGD (5)?
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Pts who fail Tx
GI bleeding/anemia Dysphagia/odynophagia Wt loss H/O Heavy NSAIDS, Ulcer disease |
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GERD Tx
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Antacids
H2 Receptor Antagonists (-tidine) PPIs QD before meals (-azoles) |
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Unresolved GERD Dx
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EGD to rule out Barrett's
pH monitoring study (surgery if abnormal) Surgical fundoplication |
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Squamous cells replaced wtih abnormal glandular-type epithelium on esophagus
Suspect in white male with GERD |
Barrett's Esophagus
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Barrett's Esophagus Issue
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Adenocarcinoma of Esophagus
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Barrett's Esophagus Dx
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Biopsy
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Orange-salmon colored change on mucosa
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Barrett's Esophagus
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Barrett's Esophagus Monitoring
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1 yr follow up EGD followed by surveillance every 3-5 ears
If dysphagia at time of Dx, monitor with yearly EGD |
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Barrett's Esophagus Tx
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Longer-term PPI therapy/ablation
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Stomach Disorders (4)
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PUD
NSAID Gastropathy Zollinger Ellison Syndrome Gastric carcinoma |
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More serious, but less common ulcer
Appears in older patients |
Gastric Ulcer
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Most common in NSAID overuse/H. pylori
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PUD
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Assumption if pt has PUD and they are not on NSAIDs/ASA
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H. pylori
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H. Pylori Dx Methods (4)
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Serology-ELISA
Urea Breath Test Stool Antigen Endoscopic Biopsy |
Serology-ELISA = still positive after Tx
Urea Breath Test = more expensive Stool antigen = Tells if active infection, cost effective Endoscopic Biopsy = Culture can be done to deetermine if active |
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H. pylori Tx
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Amoxicillin 1 gm BID AND
Clarithromycin 500 mg BID AND PPI BID All for 10-14 days Test stool antigen to confirm eradication |
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NSAID Gastropathy Tx
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D/C NSAIDs, give with food, add PPI
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Ulcer presenting with pain being worse after eating
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Gastric Ulcer
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Ulcer presenting with pain relieved by eating
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Duodenal Ulcer
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Ulcer Red Flags = Get EGD (7)
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Anemia
Weight loss Positive hemoccult stools Hematemesis/melena Persistent vomiting Dysphagia New-progressive symptoms |
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When to EGD Ulcer pts (3)
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H/O PUD
Pts with red flags Pts >50 with new onset symptoms |
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Empiric Tx v EGD for Ulcers
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<50 yo
No red flags PPI w reassessment in 4 weeks Treat H. pylori if active |
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Stomach Issues Gold Standard Dx
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EGD
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Gastric Ulcer Tx
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PPI BID x1 month
Then PPI QD x1 month EGD to confirm eradication |
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Duodenal Ulcer Tx
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PPI BID x1 month
Then PPI QD x1 month Do not have to rescope with EGD |
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PUD + Peritoneal Signs/Ileus
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Perforation
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PUD + Gastric Outlet Obstruction
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Vomiting after meals
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PUD + Bleeding
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Positive hemoccult/melena
Anemia |
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Gastrinoma of pancreas or duodenum
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Zollinger-Ellison Syndrome
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Recurrent PUD
PUD with hypercalcemia Neg H. pylori, NSAID/ASA use Severe abdominal pain/diarrhea Serum gastrin level >150 |
Zollinger-Ellison Syndrome
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Most common cancer worldwide, but uncommon in US
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Gastric Carcinoma
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Ulcer pt that loses weight
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Gastric
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Ulcer pt that gains weight
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Duodenal
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Indirect Bilirubin--Water Soluable?
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No, urine color normal
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Direct Bilirubin--Water Soluable?
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Yes, dark colored urine
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3 main causes of Indirect Bilirubinemia
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Hemolysis
Gilbert's Crigler-Najjar |
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Pre-liver issue
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Indirect Bilirubinemia
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Post-liver issue
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Direct Bilirubinemia
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Indirect bili is high
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Indirect Bilirubinemia
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Total and direct bili is high
Indirect is normal |
Direct Bilirubinemia
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3 causes of Direct Bilirubinemia
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Hepatocellular dysfunction
Biliary obstructioni Dubin-Johnson syndrome |
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Gallstones
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Cholelithiasis
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Gallstones in cystic duct
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Cholecystitis
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Stone in common bile duct
LFTs elevated |
Choledocholithiasis
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Bacteria in biliary tree
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Cholangitis
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Male autoimmune disease with Ulcerative Cholitis
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Primary Sclerosing Cholangitis
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Cholesterol stones
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Cholelithiasis
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5 F's of Cholelithiasis
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Female
Fat Forty Fertile Fair |
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Transient cystic duct obstruction
Nocturnal pain is common |
Biliary Colic
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Sustained obstruction of the cystic duct
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Acute Cholecystitis
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Murphy's Sign
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Acute Cholecystitis
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Biliary colic
Jaundice because stone has moved out of gallbladder Elevated LFTs |
Choledocholithiasis
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Gallstone pancreatitis
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Choledocholithiasis
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Adenocarcinoma Esophageal Cancer Pts
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Barrett's Esophagus (White males)
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Esophageal Cancer Dx
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EGD for biopsy
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Esophageal Cancer Tx
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Surgical/Onc
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Why use Barium Swallow?
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Machanical v. motility disorders
Dilation and beaking (achalasia) Rings, strictures, Zenker's Diverticulum |
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Why use Manometry
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Assesses peristalsis in Achalasia
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Uncomplicated GERD Tx
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4 weeks on PPI
Test/treat for H. pylori |
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Reasons to send GERD pt for EGD (5)?
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Pts who fail Tx
GI bleeding/anemia Dysphagia/odynophagia Wt loss H/O Heavy NSAIDS, Ulcer disease |
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GERD Tx
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Antacids
H2 Receptor Antagonists (-tidine) PPIs QD before meals (-azoles) |
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Unresolved GERD Dx
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EGD to rule out Barrett's
pH monitoring study (surgery if abnormal) Surgical fundoplication |
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Squamous cells replaced wtih abnormal glandular-type epithelium on esophagus
Suspect in white male with GERD |
Barrett's Esophagus
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Gallstone Pancreatitis
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Choledocholithiasis
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Charcot's Triad symptoms
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Fever >40
RUQ pain Jaundice |
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Reynold's Pentad symptoms
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Fever >40
RUQ pain Jaundice Altered Mental Status Hypotension |
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Charcot's Triad
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Cholangitis
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Reynold's Pentad
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Cholangitis
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First line Dx for liver/gallbladder
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US
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Dx used when pt has continual gallbladder pain but normal US
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HIDA
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Pain = Functional biliary Disease
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ERCP uses
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Dx and Tx:
Cholangitis Choledocolithiasis |
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ERCP Risk
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Pancreatitis
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Elevated AlkPhos (4)
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Congestion of liver
Cirrhosis Obstruction Sitting Bili |
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Increased ALT/AST (2)
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Hepatitis
Hepatocites destroyed |
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Autoimmune, older women
Fatigue, jaundice, puritis, mild hepatomegally Elevated AlkPhos |
Primary Biliary Cirrhosis
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Primary Biliary Cirrhosis Dx
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+AMA
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Used to stage inflammation/fibrosis in Primary Biliary Cirrhosis
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Liver Bx
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Primary Biliary Cirrhosis Tx
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Bile acid sequestrant (URSOdiol)
Cure = transplant |
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Younger women with no serological evidence of viral hep or history of ETOH, parenteral exposure
Fatigue, anorexia, arthralgias, jaundice |
Autoimmune Hepatitis
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Elevated transaminases
+ANA +ASMA |
Autoimmune Hepatitis
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Used to stage inflammation/fibrosis in Autoimmune Hep
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Liver Bx
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Tx of Autoimmune Hep
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Prednisone
Immunomodulators (Azothioprine) |
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Autoimmune, post-infectious, vascular liver disease
Young men Associated with IBD/UC |
Primary Sclerosing Cholangitis
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Chronic inflammation and fibrosis of the bile duct system
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Primary Sclerosing Cholangitis
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Elevated TB, Alk Phos
ERCP shows thick/narrowed bile duct system |
Primary Sclosing Cholangitis
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Klatskin tumor
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Cholangiocarcinoma
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Most common location for Cholangiocarcinoma
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Junction of R and L main hepatic ducts
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Nontender palpable gallbladder w H/O of weight loss
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Cholangiocarcinoma
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Caused by gallstones, chronic ETOH abuse, Type IV hypertriglyceridemia, ERCP, meds
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Acute Pancreatitis
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Meds that cause Acute Pancreatitis (4)
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Azothioprine
Pentamide Valproate Thyazides |
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Pancreas Imaging
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CT
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Increased S. amylaase and S. lipase
Leukocytosis with a left shift |
Acute Pancreatitis
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Acute Pancreatitis Imaging
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CT
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Acute Pancreatitis Reasons to Admit (6)
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Encephalopathy (altered MS)
Hypoxemia Tachycardia with hypotension HCT >50 (dehydration) Oliguria Azotemia |
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Ranson's Criteria for Necrotizing Pancreatitis (3 or more of 6)
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Age >55
WBC >16000 Blood Sugar >200 Lact Dehydrogenase >350 AST >250 Low S. Calcium |
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Complications of Acute Pancreatitis (4)
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ARDS
Necrotizing pancreatitis Chronic pancreatitis/malabsorption Pancreatic Pseudocyst (late) |
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Late stage complication of Acute Pancreatitis
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Pancreatic Pseudocyst
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Pancreatic Pseudocyst Tx
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Monitor or drain percutaneously or via EGD
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#1 cause of Chronic Pancreatitis
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Chronic ETOH abuse
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Dx of Chronic Pancreatitis
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CT of abdomen to look for cacifications
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Chronic Pancreatitis Tx
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Pain Mangagement
Low fat diet No ETOH CCK Pancreatic enzymes |
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Most common site of Pancreatic Cancer
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Head
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Painless jaundice
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Pancreatic Cancer
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Pancreatic Cancer Tumor marker
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CA 19-9
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2 Liver Function Tests
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Albumin
Coagulation Factors (PT/INR) |
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4 Liver Enzyme Tests
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AST
ALT AlkPhos GGTP/5'nucleotidase |
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What ALT/AST tests indicate
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Elevated in hepatocellular inflammation or destruction/necrosis
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Test for bone or liver enzymes
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AlkPhos
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How to differentiate AlkPhos elevation of liver from bone
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Elevated AlkPhos with elevated GGTP/5'nucleatidase
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Copper overload
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Wilson's Disease
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Iron overload
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Hemochromatosis
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Arthralgias, hepatomegally, gray skin, cardiomegally, conduction disorders, DM, ED
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Hemochromatosis
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Increased % transferrin sat
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Hemochromatosis
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Hemochromatosis Tx
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Weekly phlebotomy
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Kay-Fleischer ring on eye exam
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Wilson's Disease
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Wilson's Disease Tx
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Penicillamine
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ALT>AST (+20x elevated)
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Viral Hepatitis
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Most common Hep in US
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Hep A
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Hep A transmission
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Fecal-oral
(foreign travel) |
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Hep A: acute or chronic?
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Acute
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Immunoglobin in acute Hep A infection
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IgM
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Immunoglobin suggesting immunity in Hep A
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IgG
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Immunoglobin pneumonic
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IgM is up when you are Miserable
IgG is up when it is Gone |
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Hep B transmission
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Blood
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Hep that is major risk factor for Hepatocellular Cancer
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Hep B
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Hep that is easier to transmit sexually: Hep B or C?
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Hep B
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Hep more likely to become chronic: Hep B or C?
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Hep C
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Hep A Tx
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None
Avoid ETOH/drugs metabolized by liver |
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Heps that have vaccine
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Hep A and B
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Indicates Hep B is actively replicating
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HBsAg
(surface antigen) |
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Indicates Hep B immunity
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AntiHBsAg
(surface antibody) |
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Indicates past Hep B infection
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AntiHBcAg
(core antigen) |
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Indicates able to transmit Hep B infection
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HBeAg
(open envelope) |
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Indicates unable to transmit Hep B infection
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AntiHBe
(closed envelope) |
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Hep that can only replicate if HepBsAg is present
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Hep D
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Most common blood-borne infection
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Hep C
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Leading cause of chronic liver failure
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Hep C
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Most common indication for liver transplant
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Hep C
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When must you screen for Hep C (3)
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Life insurance exams
Employment screenings Prenatal care |
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Hep C screening
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EIA
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Hep C Dx Confirmation
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If EIA positive, RIBA to confirm
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Hep C RNA used to establish Hep C chronicity and for theapeutic management
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Viral load testing
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Used to stage inflammation/fibrosis of Hep C
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Liver Bx
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Excludes pts from Hep C Tx (3)
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Major psych illness
Ongoing ETOH or substance abuse Comorbid conditions (ie, immunocompromised) |
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Hep C Tx
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Pegylated interferon plus ribavirin
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Most common cause of cirrhosis
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Alcoholic Hep
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AST>ALT (rarely above 300)
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Alcoholic Hep
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Alcoholic Hep Tx
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Abstinance
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Mildly elevated AST/ALT and AlkPhos levels
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Nonalcoholic Fatty Liver
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ALT>AST
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Nonalcholic Fatty Liver
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AST/ALT >2.0
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ETOH
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Nonalcoholic Fatty Liver Dx
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One of exclusion
Liver biopsy confirms |
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Nonalcoholic Fatty Liver Tx
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Weight loss
Fat restriction Exercise |
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Most common metastatic Cancer
|
Hepatocellular Neoplasm
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Origin of Hepatocellular Neoplasns
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Lung
Colon Breast Prostate |
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Hepatocellular carcinoma Tumor Marker
|
AFP
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Small Bowel Diseases (3)
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Inflammatory Bowel Diseease (Crohn's)
Obstruction Mesenteric Ischemia |
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Crohn's v. UC: Transmural, so causes inflammation, strictures, and fistulas
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Crohn's
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Crohn's v. UC: Superfiscial, friable
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UC
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Crohn's v. UC: Typically spares the rectum
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Crohn's
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Crohn's v. UC: "skip lesions"
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Crohn's
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Crohn's v. UC: cobblestoning
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Crohn's
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Crohn's Dx
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Colonoscopy
(Biopsy is gold standard) |
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Crohn's v. UC: string sign
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Crohn's
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Crohn's v. UC: Malabsoption of B12 and fat
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Crohn's
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Crohn's cancer risk
|
Small bowel adenocarcinoma
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Crohn's Colitis monitoring
|
Colonoscopy after 7-8 years and then every 1-2 years
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Crohn's v. UC: surgery cures
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UC
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Crohn's v. UC: Surgery treats complications, but does not cure
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Crohn's
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Crohn's 1st line maintanence Tx
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Aminoslicylates/5ASAs (mesalamine)
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Crohn's 2nd line maintanence Tx
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Immunomodulators (azothioprine, 6mp)
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Crohn's 3rd line maintanence Tx
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Biological Therapies (remicade, humira, cimzia)
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Crohn's flare Tx
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Corticosteroids (prednisone, entocort)
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Crohn's infection Tx
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Antibiotics (flagyl, xifaxin)
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Crohn's Tx (5)
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Aminosalicylates/5ASAs
Corticosteriods Immunomodulators Antibiotics Biological Therapies (-mab) |
Mesalamine
Prednisone, Entocort Azothioprine, 6mp Flagyl, Xifaxin Remicade, Humira, Cimzia |
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Immunomodulators (Azothioprine, 6mp) Warnings
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Pancreatitis risk
Check LFTs/CBC every 90 days |
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Poor absorption in Crohn's (2)
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B12
Fat |
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Air/fluid level on upright KUB
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Small Bowel Obstruction
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Most common cause of SBO
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Adhesions
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SBO Tx
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Nasogastric tube
Bowel rest Surgery if not resolved |
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>50 yo with h/o attherosclerotic heart disease causeing hypoperfusion of bowel vasculature
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Mesenteric Ischemia
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Sudden, severe, abdominal pain that is out-of-proportion
Positive hemoccult Pain is post-prandieal |
Mesenteric Ischemia
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Mesenteric Ischemia Dx
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Angiography
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Mesenteric Ischemia Tx
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Angiography
Surgery |
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Malabsorption Syndromes (3)
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Celiac Sprue
Pancreatic Insufficiency Short Bowel Syndrome |
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Loss of absorptive surface results in malabsorption
Abnormal immune response to gluten |
Celiac Sprue
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Celiac antibodies (2)
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IgA endomysial antibiody
IgA tTG antibody |
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Celiac gold standard Dx
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Mucosal biopsy showing villous atrophy and blunting of villi duodenum
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Villous atrophy and blunting of villi duodenum
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Celiac
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Celiac Malabsortption Deficiencies (4)
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Fe
Ca Vit D B12 |
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Dermatitis herpetiformis
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Celiac derm condition
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Pruritic paluovesicles over extensor surfaces and the trunk and neck
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Dermatitis Herpetiformis
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Clue to Celiac
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Celiac Tx
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Gluten free diet
No BROW Barley Rye Oats Wheat |
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Celiac pts can eat
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CRAP
Corn Rice Arrowroot Potatoes |
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Secondary to reoval of small intestine
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Short Bowel Syndrome
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More than 50 cm of ileum is resected
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Short Bowel Syndrome
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Short Bowel Syndrome Tx
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Monthly B12 Injections
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Early symptoms include poorly localized periumbilical abdominal pain
Pain localizes to the right local abdominal quadrant |
Appendicitis
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McBurney's
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Appendicitis
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Appendicitis Differential Work-up
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Pelvic US
Leukocytosis with PMN predominant |
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Appendicitis Dx
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CT
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Large Bowel Diseases (7)
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Constipation/fecal impaction
UC Diverticulitis Diverticulosis Toxic Megacolon Large Bowel Obstruction Colon Cancer |
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Meds that cause Constipation (6)
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Narcs
Diuretics CCBs Calcium supplements Fe supplements Cholestyramine |
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Structural cause of constipation
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Colorectal masses
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Systemic causes of constipation (4)
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Hypothyroidism (Toxic Megacolon)
DM Parkinson's MS |
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Fecal Impaction Differential Work-up
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DRE
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Fecal Impaction Tx
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Disimpaction
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Crohn's v. UC: LLQ pain and bloody diarrhea
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UC
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UC Dx
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Colonoscopy and biopsy
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Crohn's v. UC: inflammation begins in distal rectum and spreads proximally
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UC
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Crohn's v. UC: Continuous lesion
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UC
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Crohn's v. UC: Sharp demarcation between normal mucosa and ulcers
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UC
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Crohn's v. UC: Rectum is always involved
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UC
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Waking up in middle of night for BM
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Crohn's or UC
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Crohn's v. UC: Erythema, friable mucosa
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UC
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Crohn's v. UC: Crypt abscess, architecture distortion
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UC
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UC complications (3)
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Toxic Megacolon
Perf Colon cancer |
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UC Cancer Surveilance
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Colonoscopy yearly after 7-8 years
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UC Tx (5)
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Aminosalicylates/5ASA
Corticosteroids (prednisone taper) Immunosuppressives (azothrioprine/6mp) Tumor necrosis factor/biologics (Infliximab) Surgery |
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Only curative UC Tx
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Surgery
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Believed to be due to chronic low-fiber diets
No infection |
Diverticulosis
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Diverticulosis Tx
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Avoid popcorn
Eat high fiber diet |
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Most common cause of lower GI bleeds in >50yo
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Diverticular hemorrhage
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Acute, painless, large volume maroon or BRB in patients >50 yo
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Diverticular hemorrhage
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Micro-perf of a diverticulum resulting in acute infection of bowel wall
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Diverticulitis
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LLQ pain and mass
Fever Leukocytosis May see constipation leading up to attack |
Diverticulitis
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When is CT necessary in diverticulitis?
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If symptoms don't resolve in 2-4 days on meds
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Diverticulitis No-no's
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Barium enema
Scoping acutely |
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Elderly diverticulitis Tx
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IV Metronidazole and Cipro for 10-14 days
(broad spectrum and anaerobic coverage) |
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2+ Diverticulitis Attacks
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Surgical consultation for elective resection (typically sigmoid)
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BRB per Rectum imaging (3)
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Anoscope or DRE at minimum
Rigid/Flex sig Colonoscopy is both Dx and Tx |
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What precedes most colon cancer
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Adenomas
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Microcytic anemia + >50
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Colon Cancer
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Weight loss and obstuction
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Late stage symptoms of colon cancer
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Second most common cause of cancer death
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Colon cancer
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Leading cause of cancer death
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Lung cancer
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Peutz-Jeghers syndrome
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Familial colon cancer
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Associated with colorectal cancer, endometrial cancer, ovarian cancer
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HNPCC
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Colon Cancer Screening
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Annual FOBT >50yo
Sigmoidoscopy with polyp removal every 5 years >50 yo, plus yearly FOBT Barium enema every 5-10 years Colonoscopy every 10 years |
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Annual FOBT rules
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No red meat for three days
Three consecutive stools |
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First degree relative with cancer >60 screening
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Age 40 (colonoscopy preferred)
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First degree relative with cancer <60 screening
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Screen ten years younger than age at dx
Colonscopy every 3-5 years |
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IBD patient cancer screening
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Colonoscopy 8 years after diagnosis
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Familial adenomatous polyposis cancer screening
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Sig at age 12 (genetic screening after age 10)
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HNPCC cancer screening
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Genetic testing available
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Tear at rectal sphincter
Dyschezia Hematochezia |
Anal Fissure
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Anal Fissure Dx
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DRE with equisitie tenderness posterior midline position
Anal skin tag |
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Dilations of the vascular bed
Painless hematochezia |
Hemorrhoids
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Above Dentate line
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Internal Hemorrhoids
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Below Dentate line
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External Hemorrhoids
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Chronic >3mo lower GI symptoms
Relieved with defecation Change in frequency of stool Change in stool caliber |
IBS
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Not bloody, not nocturnal passage of mucosy stool
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IBS
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Night blindness
Poor wound healing |
Vitamin A
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ETOH
BeriBeri High output CHF/Wernicke's encephalopathy |
Thiamine (B1)
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Pellagra
Dermatitis Dementia Diarrhea |
Niacin (B3)
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Anemia, Peripheral neuropathy
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Pyridoxine (B6)
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Osteomalacia
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Vit D
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Scurvy
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Vit C
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Bleeding dyscrasia
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Vit K
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What vitamins are fat soluble?
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D, E, A, K
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Vitamin B12 absorption
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Stomach
Small Intestines |
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Pernicious anemia
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Vitamin B12
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Vitamin A absorption
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Small intestines
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Vitamin B1 absorption
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Upper small intestines
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Vitamin B3 absorption (niacin)
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Stored in liver
Absorbed in intestines |
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Vitamin B6 absorption
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Jejunum
Illium |
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Protrusion of viscus through an opening in the wall in which it is contained (peritoneum sac)
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Hernias
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Through the internal inguinal ring
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Indirect Inguinal Hernia
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Through the back wall of the inguinal canal
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Direct Inguinal Hernia
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Protrusion through the femoral ring
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Femoral Hernia
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Infants; adults (acquired)
Type of hernia |
Umbilical Hernia
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History of previous surgery
Type of hernia |
Incisional Hernia
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Stomach/intestines protrudes into chest cavity through diaphragm defect
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Hiatal Hernia
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When Hernias recquire emergent repair
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Incarcerated
Strangulated |
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Bright red blood in vomit
Coffee ground emesis |
Hematemesis
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Black tarry stool
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Melena
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Upper GI Dx
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Endoscopy
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Upper GI Tx
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Endoscopy
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Causes of UGI bleeding (6)
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PUD
Varices NSAID gastropathy Mallory-Weiss Tear Vascular Ectasias and AVMs Boerhaave's syndrome |
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Boerhaave's syndrome
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Ruptured esophagus
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Bleeding that occurs below the Ligament of Treitz
Anemia Hematochezia |
Lower GI Bleeding
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Where most Lower GI bleeding occurs
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Colon
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Causes of Lower GI Bleed in pts <50yo (3)
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Infectious colitis
IBD Anorectal disease (fissures/hemorrhoids) |
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Causes of Lower GI Bleed in pts >50 (7)
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Diverticulosis bleed
Neoplasm Vascular ectasias IBD Anorectal disease Ischemic colitis Unknown |
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Occult GI Blood Loss in pts >40-45 (6)
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Neoplasm
Vascular ectasias PUD Infectious diseases NSAIDs IBD |
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Healthy 35yo nonsmoker/drinker with dyspepsia comes in failing tums daily. No anemia, wt loss, overt GI blood loss, family history, or regular NSAID use
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Do you:
A. Send for EGD B. Place on PPI daily and check back in one month C. Order 24 hr pH monitoring study D. Send for barium swallow |
B
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59yo male with ETOH/tobacco history presents with rare episodes of new solid food dysphagia. No wt loss, overt GI blood loss, anemia, GERD symptoms, oor family histor. He isn't too concerned as it only occurs every other week and resolves.
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What sould be the best next step:
A. Place on PPI and follow up in one month B. Order a barium swallow study C. Plan for EGD D. Treat him for presumed Barrett's Esophagus on PPI daily and follow up in one year |
C
Checking for squamous cell esophageal carcinoma |
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65yo male with recent regurgitation of food in am upon awakening. Also complains of coughing with PO intake, occasionally food becoming stuck as well. Has new infiltrate on CXR.
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The next best step would be:
A. Place on PPI and F/U in one month B. Plan for EGD C. Arrange barium swallow/esophagram D. Arrange for esophagram first, followed by EGD |
D.
Zenker's |
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56yo female with h/o arthritis presents with DOE, black tarry stools, hgb 6/hct 15 and using NSAIDs regularly.
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You recommend:
A. EGD B. D/C unnecessary NSAIDs C. Transfusion D. Add PPI if NSAID is required E. All of the above |
E
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Overweight healthy 48yo male with following labs: AST/ALT normal, total bili 2.8, direct bili normal.
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From this you suspect:
A. Pt is a drinker B. Pt has fatty lifver C. Pt has Gilbert's disease D. Pt could have gallstone |
C
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19yo overweight healthy female with 2 yr h/o 4-5 nonbloody BMS daily (occasionally nighttime), abdominal cramping; wt loss and family history of thyroid and rheumatoid in her mother.
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Your next best step is:
A. Place on high fiber and manage symptoms (antispasmotics, antidiarrhea meds) B. Check blood work (TSH, CBC, Sed Rate, CRP, Celiac markers) C. Arrange for colonoscopy D. Both B and C |
D
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29yo male with UC, c/o fatigue, jaundice, pruritis, fatigue, and elevated LFTs, Alk Phos and total bili
|
You suspect:
A. Primary Biliary Cirrhosis B. Autoimmune hep C. Hemocromatosis D. Primary Sclerosing Cholangitis E. Fibrotic disease of the intra/estrahepatic biliary ducts |
D and E
(same) |
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38yo w infertility, iron deficiency anemia, abd pain and irregular bowel habit.
|
You suspect:
A. Lactose Intolerance B. IBS C. Celiac sprue D. UC E. Crohn's |
C
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Positive AMA and Alk Phos in 50yo woman with fatigue, jaundice, pruritis.
|
A. Primary Billiary Cirrhosis
B. Primary Sclerosing Cholangitis C. Autoimmune Hep D. Wilson's Disease E. Cholangiocarcinoma |
A
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ETOH binge drinking 16yo woman gives h/o multiple episodes of bilious vomit followed by painless hematemesis. Hemodynamically stable.
|
You suspect:
A. Borrhaave's Esophagus B. Barrett's Esophagus C. Mallory-Weiss tears D. Esophageal Varix E. Infectous Esophagitis |
C
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25yo female wt lifter with 2 new episodes of painless hematochezia this week. No unexplained wt loss, change in bowel habit, family hx or abd pain.
|
You first:
A. Provide info about fiber and hemorrhoids. F/U in office in one month B. Arrange for flex sig/colonoscopy C. DRE |
C
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59yo woman with previous finding of diverticular disease on colonoscopy last year presents with new onset LLQ abd pain, low grade fever, but otherwise appears healthy. No prior history of similar presentation.
|
Your best management is:
A. Arranging for colonoscopy B. Arrange for barium enema C. Arrange for surgical referment D. Place pt on cipro and metronidazole E. Advise liquid diet followed by bland diet with later recs for high fiber diet. F. Both D and E |
F
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